(I)Company Demographic Profile

(I)Company Demographic Profile

Job Categories / Number of Employees (report employees in only one category)
Race/Ethnicity
Non-Hispanic or Latino / Overall Totals
Hispanic or Latino / Male / Female
Male / Female / White / Black or African-American / Native Hawaiian or Other Pacific Islander / Asian / American Indian or Alaska Native / Two or More Races / White / Black or African-American / Native Hawaiian or Other Pacific Islander / Asian / American Indian or Alaska Native / Two or More Races
Executive/ Senior Level Officials and Managers
First / Mid-Level Officials and Managers
Professionals
Technicians
Sales Workers
Administrative Support Workers
Craft Workers
Operatives
Laborers and Helpers
Service Workers
Total

(NOTE: proposers can also attach Employer Information Reports EEO-1 for the last 3 years)

(II)MWBE Certification Status

1. Is your company certified as a Minority and/or Woman-owned business enterprise with New York State Empire State Development? Yes or No

If yes, provide a copy of your certification.

2. If no, list all other jurisdictions and/or certifying bodies that have deemed your company Minority and/or Woman-owned. Also, provide a copy of each certification.

3. If your company has applied for, but has not, as of the issuance of the RFP, been certified as a Minority or Women-owned business enterprise by New York State Empire State Development, you must submit proof of a pending application, including the filing date.

(III)Demographic Profile of Staff Assigned to this Engagement

(IV)EEO Firm Activity

1. Is your company’s CEO or Chief Procurement Officer (“CPO”) committed to and engaged in the process of diversity business development? Yes or No

If yes, attach a signed statement from your CEO or CPO.

2.Provide a copy of your company’s equal opportunity and affirmative action policy.

Diversity QuestionnairePage 1 of 2

Ver. 7/7/15